Thoracic aortic surgery with circulatory arrest and cold cerebral perfusion

• Published in: Chirurg Vol. 80; no. 11; pp. 1059 - 1065
• Main Authors: Khaladj, N, Hagl, C, Shrestha, M, Peterss, S, Winterhalter, M, Hoy, L, Pichlmaier, M, Haverich, A
• Format: Journal Article
• Language: German
• Published: Germany 01.11.2009
• Subjects: Adult; Aged; Aged, 80 and over; Aorta, Thoracic - surgery; Aortic Diseases - mortality; Aortic Diseases - surgery; Aortic Valve - surgery; Blood Vessel Prosthesis Implantation; Brain - blood supply; Brain Damage, Chronic - diagnosis; Brain Damage, Chronic - mortality; Combined Modality Therapy; Coronary Artery Bypass; Female; Heart Valve Prosthesis Implantation; Heart-Lung Machine; Hospital Mortality; Humans; Hypothermia, Induced - methods; Male; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - mortality; Regional Blood Flow - physiology; Reoperation; Retrospective Studies; Risk Factors; Survival Rate; Young Adult
• ISSN: 1433-0385
• DOI: 10.1007/s00104-009-1698-8

This study was undertaken to identify pre- and perioperative risk factors to mortality and permanent neurological dysfunction (PND) and temporary neurological dysfunction (TND) in a large patient cohort, all operated under moderate hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SACP) in a single centre. Between November 1999 and March 2006, 319 patients at a median age of 65 years (range 21-86, 201 male) underwent elective aortic arch surgery with moderate HCA at 25 degrees C and additional SACP at 14 degrees C. Sixty-nine had additional coronary artery bypass grafts or valve procedures. Ninety-four (29%) had total arch repair. Statistical analysis was carried out to determine the risk factors for 30-day mortality as well as for TND and PND. Overall mortality was 7.8% (15% in cases with repeat surgery vs 4.8% in nonrepeats, P=0.002). Twenty-seven (8.5%) suffered from PND, and six (22%) died during hospital stay (P=0.004). There was TND detected in 32 patients (10%). Stepwise logistic regression revealed age (P=0.001, OR 1.09/year), repeat surgery (P=0.008, OR 5.04), preoperative neurological events (P=0.004, OR 3.44), CAD (P=0.051, OR 3.58), and cardiopulmonary bypass duration (P<0.001, OR 1.01/min) as risk factors for mortality. The PND was associated with preoperative renal insufficiency (P=0.026, OR 3.34) and operation duration (P<0.001, OR 1.01/min), whereas TND occurred in patients with coronary artery disease (P=0.04, OR 2.41), and prolonged cardiopulmonary bypass duration (P=0.05, OR 1.01/min). Thoracic aortic surgery including aortic arch using HCA and SACP can be performed with excellent results in elective patients, especially those without previous surgery. Nevertheless PND is associated with high hospital mortality. Neurological complications seem to be strongly associated with general atherosclerotic changes as well as the extent of surgery.